Provider Demographics
NPI:1568427078
Name:PENA, WILLIAM R (MD)
Entity Type:Individual
Prefix:DR
First Name:WILLIAM
Middle Name:R
Last Name:PENA
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:7050 TAFT ST
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33024-3804
Mailing Address - Country:US
Mailing Address - Phone:954-399-9014
Mailing Address - Fax:954-367-7175
Practice Address - Street 1:6517 TAFT ST STE 102
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33024-4063
Practice Address - Country:US
Practice Address - Phone:954-399-9014
Practice Address - Fax:954-367-7175
Is Sole Proprietor?:No
Enumeration Date:2006-04-18
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
FLME84291174400000X, 207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263658100Medicaid
FLF55671Medicare UPIN
FL15937AMedicare ID - Type Unspecified